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Questions 164

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Question 1 of 5

The nurse in a long-term care facility is talking with a client with multiple sclerosis who states, 'I want to live in my own home again.' Which of the following responses would be most appropriate for the nurse to make?

Correct Answer: D

Rationale: Encouraging the client to express their concerns promotes client-centered care and helps the nurse understand the client's motivations and needs for returning home.

Question 2 of 5

A client recovering at home following a left total knee replacement 7 days ago is using a cane to go up and down the stairs under the supervision of the home health nurse. Which client action indicates a need for reinforcement of teaching?

Correct Answer: D

Rationale: Placing full weight on the surgical leg when going down stairs risks injury and instability. The client should lead with the cane and unaffected leg, using the surgical leg cautiously.

Question 3 of 5

A 16 month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her and begins to cry. What would be the initial action by the nurse?

Correct Answer: B

Rationale: Explain that this behavior is expected. Fear of strangers is normal in toddlers and extends into the preschool period.

Question 4 of 5

A 35-year-old client of Puerto Rican-American descent is diagnosed with ovarian cancer. The client states, 'I refuse both radiation and chemotherapy because they are 'hot.' The next action for the nurse to take is to

Correct Answer: D

Rationale: ask the client to talk about concerns regarding 'hot' treatments. The 'hot-cold' system is found among Mexican-Americans, Puerto Ricans, and other Hispanic-Latinos. Most foods, beverages, herbs, and medicines are categorized as hot or cold, which are symbolic designations and do not necessarily indicate temperature or spiciness. Care and treatment regimens can be negotiated with clients within this framework.

Question 5 of 5

The nurse is planning care for a client who has a hearing impairment. Which action will likely help the most with communication?

Correct Answer: C

Rationale: Speaking slowly and clearly enhances comprehension for hearing-impaired clients. Repeating, shouting, or gestures may confuse or overwhelm.

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